2027 Governor's Volunteer Service Award Nomination Form

The Governor's Volunteer Service Award (GVSA) honors the true spirit of volunteerism by recognizing individuals who significantly contribute to their community through volunteer service. Before completing the nomination form, please review the GVSA eligibility guidelines below.

1. Nominees must have been engaged in volunteer activities for at least one year in North Carolina. Volunteer service performed outside the state is ineligible.

2. Nominees are ineligible if they receive compensation for their service.

----- This includes service done for school credit, as a “loaned executive”, or for other forms of compensation.

3. Nominees are ineligible if they are required to do the service.

----- This includes service mandated by schools, the court, or other authorities.

4. Self-nominations are ineligible.

5. Previous award recipients from within the past 10 years are ineligible.

6. Family members may not nominate their family members.

7. Group nominees must be nominated by someone external to the group.

Important Submission Requirements

1. All nominations must be submitted via this online nomination form.
2. All required parts of the nomination form must be completed.
3. The nomination form must be signed and dated by the nominator.
4. Additional information and/or supporting documents will not be accepted.
5. Nominations must be submitted by the deadline.
6. One additional reference is required for each nomination.

Award Selection

Award selections are based on the nominee’s volunteer efforts and commitment of time, accomplishments, community impact, and enhancement of the lives of others. Nominations are evaluated by the appropriate County Award Coordinator who submits up to 10 nominations to VolunteerNC. Of the submitted, one may be recommended (at the discretion of the County Award Coordinator) for the Governor's Medallion Award for Volunteer Service, the highest level of volunteer recognition in the state. Please note if a group is awarded the Medallion, only one physical medallion is given, and extra medallions are not available for purchase.

GVSA recipients are selected based on merit and eligibility and without regard to race, ethnicity, religion, gender, national origin, or physical/mental disability.

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1. Volunteer's Name (First and Last Name or Group Name) (Required.)

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2. Volunteer's Title (Optional):

Dr.

Rev.

Hon.

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3. Volunteer's Home Address (for Group nominees, please list the organization's address) (Required.)

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4. Volunteer's Phone Number (Required.)

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5. Volunteer's Email Address (Required.)

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6. Please check the appropriate nominee age bracket box below: (Required.)

Youth: A volunteer who is 18 years old or younger

Young Adult: A volunteer who is 19-30 years old

Adult: A volunteer who is 31-59 years old

Senior: A volunteer who is 60 years old or older

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7.
Special Volunteer Type: (Required)
(Required.)

Individual: One person providing outstanding volunteer service

Group: Two or more individuals who volunteer together as a team

National Service Member: Anyone who volunteers with a National Service program (AmeriCorps, VISTA, Senior Corps)

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8.
Area of Volunteer Service: (Mark all that apply. Minimum 1 response req.)
(Required.)

Veteran/Military: Notable service to military families or veterans.

Youth Service: Extraordinary commitment to mentoring or educating youth.

Seniors: Significant devotion to assisting older adults.

Historically Underserved Populations: Noteworthy dedication to assisting marginalized populations.

Disaster: Remarkable volunteerism in disaster preparedness, response, recovery, or mitigation activities.

Animals: Outstanding dedication to animal welfare.

Cultural: Remarkable devotion to restoring or preserving history, culture, or the arts.

Environment: Exceptional commitment to environmental stewardship.

Health & Human Services: Significant devotion to those in need.

Lifetime Achievement: An individual who has exhibited a lifelong commitment to volunteerism and community service. Nominees must have made a substantial and long-term sustained impact on the community because of their service efforts.

Other: Areas of service not listed above.

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9.
Nominator Information
(Required.)

Nominator Name (will act as online signature) *

Relationship to Nominee (i.e. volunteer supervisor)

Email Address *

Phone Number *

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10. Please select your prefered method of contact (Required.)

Phone

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11.
Service Details (for the past year only):
For the below, provide an estimate. For group nominations, provide a combined estimate.
(Required.)

Organization(s) where the nominee volunteers:

County where service is performed:

Number of hours volunteered per month:

Number of hours volunteered per year:

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12. Describe the nominee’s outstanding commitment to volunteerism and the agency or organization they serve. Describe accomplishments and how the impact of their service has helped meet critical needs in their community. If possible, please include measurables (numbers or quantities) that explain the nominee’s impact. Focus on service for the past year only – except for lifetime achievement nominees.

150 words minimum (Required.)

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13. Reference #1 (Organization of Service)
One additional reference is required. For the nomination to be accepted, the nominator and at least one reference from the organization of service must provide their contact information.
The nominator may not serve as the only reference. (Required.)

Name:

Organization Name:

Job Title:

Relationship to Nominee (i.e. volunteer supervisor):

Phone Number:

Email Address:

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14. Reference #2 (Optional)

Name:

Organization Name:

Job Title:

Relationship to Nominee (i.e. volunteer supervisor):

Phone Number:

Email Address:

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15. ATTESTATION* (Required.)

I attest that this nominee is an outstanding volunteer with good character and worthy of this award. I am not related to the nominee nor part of the nominee group.

DON'T FORGET TO CLICK SUBMIT !

2027 Governor's Volunteer Service Award Nomination Form

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* 1. Volunteer's Name (First and Last Name or Group Name) (Required.)

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* 2. Volunteer's Title (Optional):

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* 3. Volunteer's Home Address (for Group nominees, please list the organization's address) (Required.)

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* 4. Volunteer's Phone Number (Required.)

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* 5. Volunteer's Email Address (Required.)

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* 6. Please check the appropriate nominee age bracket box below: (Required.)

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* 7. Special Volunteer Type: (Required) (Required.)

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* 8. Area of Volunteer Service: (Mark all that apply. Minimum 1 response req.) (Required.)

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* 9. Nominator Information (Required.)

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* 10. Please select your prefered method of contact (Required.)

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* 11. Service Details (for the past year only):For the below, provide an estimate. For group nominations, provide a combined estimate. (Required.)

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* 13. Reference #1 (Organization of Service)One additional reference is required. For the nomination to be accepted, the nominator and at least one reference from the organization of service must provide their contact information.The nominator may not serve as the only reference. (Required.)

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* 14. Reference #2 (Optional)

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* 15. ATTESTATION* (Required.)

1. Volunteer's Name (First and Last Name or Group Name) (Required.)

2. Volunteer's Title (Optional):

3. Volunteer's Home Address (for Group nominees, please list the organization's address) (Required.)

4. Volunteer's Phone Number (Required.)

5. Volunteer's Email Address (Required.)

6. Please check the appropriate nominee age bracket box below: (Required.)

7.
Special Volunteer Type: (Required)
(Required.)

8.
Area of Volunteer Service: (Mark all that apply. Minimum 1 response req.)
(Required.)

9.
Nominator Information
(Required.)

10. Please select your prefered method of contact (Required.)

11.
Service Details (for the past year only):
For the below, provide an estimate. For group nominations, provide a combined estimate.
(Required.)

13. Reference #1 (Organization of Service)
One additional reference is required. For the nomination to be accepted, the nominator and at least one reference from the organization of service must provide their contact information.
The nominator may not serve as the only reference. (Required.)

14. Reference #2 (Optional)

15. ATTESTATION* (Required.)